Telerehabilitation in Neurological Patients: Evidence on Therapeutic Continuity After Hospital Discharge

Telerehabilitation in Neurological Patients: A Hybrid Model to Ensure Continuity and Functional Recovery

Telerehabilitation for neurological patients requires continuity, intensity, and structured follow-up to maximize functional recovery. However, many patients lose access to therapy shortly after hospital discharge.

A study conducted by the Mutuam Girona team, in collaboration with DyCare, analyzed how a hybrid telerehabilitation program can safely and effectively bridge this post-discharge gap, achieving high patient satisfaction.

Through a combination of digital and face-to-face sessions, the study evaluated variables such as adherence, perceived safety, functional improvement, and quality of life in individuals with recent neurological conditions.

This article summarizes the main findings and their clinical implications, offering a practical overview for healthcare professionals, patients, and rehabilitation service managers.

Loss of Continuity After Hospital Discharge

Following an acute neurological event such as stroke or Guillain-Barré syndrome, patients typically receive intensive care during the hospital and subacute phases.

This structured stage allows partial recovery of affected functions. However, the period following discharge remains critical.

In many cases, no accessible outpatient neurorehabilitation service exists in the patient’s immediate environment, leading to therapeutic discontinuity that jeopardizes the gains achieved during hospitalization.

Loss of clinical follow-up after discharge is a common weakness across multiple healthcare systems.

Limitations of the Traditional Outpatient Model

In the context of the Mutuam Girona study, several structural limitations were identified: limited resources relative to the population served, lack of dedicated outpatient neurorehabilitation units in the province, and long waiting times.

These barriers result in reduced access to rehabilitation—precisely when it is most needed.

In contrast, telerehabilitation emerges as an effective alternative.

Its implementation allows therapy to begin immediately after discharge, eliminating the need for travel and enabling increased session frequency and intensity. Moreover, patients can remain in their home environment, promoting the integration of rehabilitation into daily life.

Study Objectives

The primary goal of the study was to evaluate the feasibility and clinical outcomes of a telerehabilitation program for patients with recent neurological disorders, using the ReHub® platform.

Researchers analyzed variables such as treatment adherence, session safety, and user satisfaction with the digital format.

They also assessed clinical outcomes related to functional independence, exercise tolerance, and perceived quality of life.

This approach made it possible to evaluate not only the effectiveness of the intervention but also its acceptance and practical value as a real tool for therapeutic continuity.

Design and Methodology

The study followed a quasi-experimental design, implementing a hybrid intervention six days per week: an initial in-person control session at the Mutuam Girona Intermediate Care Hospital, followed by five consecutive digital sessions performed at home. The sixth day was reserved for rest.

The average program duration was 43 days.

The intervention was multidisciplinary, involving physiotherapy, occupational therapy, and speech therapy, depending on the patient’s needs.

Digital sessions were delivered through the ReHub® platform, which enabled performance tracking and adherence monitoring.

Safety indicators included the number of falls and technical incidents recorded during the intervention.

Participant Profile

The sample included 23 individuals with acute neurological conditions, most of whom had been diagnosed with stroke (80.77%).

The mean age was 66 years, ranging from 45 to 87. All participants were referred from intensive home rehabilitation units and selected based on their potential for functional recovery.

Inclusion criteria prioritized patients with a minimum level of autonomy, internet access, and the ability to use a digital platform.

The intervention was personalized according to each patient’s functional level and clinical diagnosis.

Telerehabilitation Outcomes: Adherence to Treatment

One of the main indicators analyzed was adherence to scheduled sessions.

• 53% of patients demonstrated high adherence

• 37% showed medium adherence

• Only 10% presented low adherence

Lower adherence was associated with more severe neurological impairment or technological barriers.

Three participants experienced connectivity or platform access issues, and two withdrew due to family contact loss.

Despite these challenges, overall adherence rates were high, confirming the operational feasibility of the hybrid model.

Safety and Tolerance of the Intervention

Safety was a central aspect of the study. No falls were reported during digital sessions.

Only one participant experienced secondary muscle overload and patellar tendinopathy, which was managed without discontinuing treatment.

These results indicate that the applied protocol supports safe home-based rehabilitation.

The ReHub® platform provides clear exercise guidelines, continuous monitoring, and visual feedback—essential elements for ensuring correct exercise execution without risk.
The initial in-person control session also contributed to establishing a safe foundation for the digital phase.

Functional Evaluation and Clinical Outcomes

Throughout the intervention period, a total of 587 sessions were conducted, averaging 22.5 sessions per patient.

The prescribed exercises included dynamic balance, strengthening, proprioception, upper limb motor control, stretching, and trunk dissociation.
In some cases, speech therapy and dysphagia treatment were also included.

77.78% of patients who completed the two-month intervention achieved functional improvement sufficient to discontinue further rehabilitation.

This finding is crucial, as it demonstrates not only the effectiveness of the program but also its capacity to close the post-acute therapeutic cycle independently.

Patient Satisfaction and Perception of Telerehabilitation

Patient satisfaction was another key aspect evaluated.

Survey results showed overall positive feedback, highlighting convenience, platform usability, and continuous professional support as main advantages.

The ability to exercise at home—without travel or waiting times—was especially appreciated.
Most participants felt that the digital format did not diminish the quality of care; instead, they felt supported, monitored, and engaged in their recovery process.

Exercise Analysis and Progression

Dynamic balance exercises were linked to the highest adherence rates, especially when intensity and complexity progressed gradually.

Conversely, patients with greater motor impairment—assigned static or self-assisted exercises—showed lower adherence levels.

This suggests that patient motivation is directly influenced by perceived functional challenge and visible progress.

Therefore, telerehabilitation protocols should be designed with a structured progression that encourages motivation while maintaining clinical safety.

Implications for Healthcare Systems

The hybrid model validated in this study helps reduce the burden on in-person rehabilitation resources while maintaining continuous clinical follow-up.
It also lowers indirect healthcare costs by preventing relapses, readmissions, and fragmented treatments.

The scalability and safety of digital formats make them essential tools for optimizing rehabilitation pathways.

Findings confirm that telerehabilitation is not merely an emergency alternative, but a complementary and sustainable care model with tangible clinical, organizational, and economic impact.

Moreover, it empowers patients to play an active role in their own recovery.

Conclusion

Telerehabilitation for neurological patients—structured through platforms like ReHub®—allows safe, effective, and satisfying therapeutic continuity after hospital discharge.
The Mutuam Girona study supports its implementation as a standard component of the rehabilitation care pathway.

The goal is not to replace face-to-face rehabilitation, but to integrate it with digital solutions that expand access, improve adherence, and optimize resource use.

This type of hybrid intervention represents a tangible step toward more modern, equitable, and effective rehabilitation care.